Friday, January 27, 2006

New ways to abuse health IT

I think I'm going to create a new department called "new ways to abuse health IT." Two such stories came to my attention today:

New York Daily News
10 years later & still a mess
Wednesday, January 25th, 2006

After the brutal killing of 6-year-old Elisa Izquierdo in November 1995, the politicians vowed to fix New York's broken child welfare system. They made the same promise again yesterday, barely two weeks after the shocking murder of yet another child, 7-year-old Nixzmary Brown. But through all their promises, they have failed to address a fiasco that has gone unresolved for nearly 10 years.

I am referring to the state's centralized child abuse information system, commonly known as Connections. Few people outside the social work community have ever heard of the system, but Connections has quietly emerged as the biggest single boondoggle in the history of our state's child welfare agencies.

My website on health IT failure is but a cautionary tale, it seems. How is it that computer systems that impact people's lives the most seem to be the biggest vortex for "biggest single boondoggles"? What underlying systemic pathologies are reflected in that fact?

Launched by Gov. Pataki only a few months after Elisa's death, this New Age information system was supposed to streamline child protective services. Pataki promised it would do away with cumbersome paper files; provide local government and nonprofit agencies access to complete case records, and create a central database of all known child abusers. Connections was heralded as the ultimate solution to child protection.

Ten years later, the problem-plagued system is still not fully operational. The original contract, hurriedly awarded to IBM and Accenture in a bidding process marked by numerous irregularities, was pegged by Pataki at $113 million. By 2001, the cost had ballooned to more than $360 million, an Assembly investigation concluded. State officials did not have an up-to-date tally available yesterday of the system's current cost.

Last Thursday, the day after Nixzmary Brown's funeral, the Connections system once again crashed at the city's child welfare offices in Brooklyn. For more than four hours, no one in the offices could get into the system to retrieve or enter information on child abuse cases, according to several city social workers. "This happens all the time," one frustrated Brooklyn caseworker told me. "It's gotten worse since they brought Build 18 [the newest version of Connections] online in Brooklyn last September."

360 million dollars? Hurriedly awarded to IBM and Accenture in a bidding process marked by numerous irregularities? These themes are all too familiar. An entire hospital system could be built for far less than $360 million. Where is this money going, one should ask? Combine this with the IT debacle that occurred at the Bay Pines VA Hospital in Florida, which was abandoned, and with just two computer projects you have nearly One Billion Dollars down the drain (or, rather, into someone's pocket; money does not simply vaporize into thin air).

In another story, a new way has been found by the MBA class, via perverse incentives that will likely be applied based on defective metrics, to make clinicians even more resistant to adopting electronic medical records systems. EMR is a tool that in the proper hands and used in the proper ways could actually improve the quality of medical care:

Plan would tie copayments to doctors' rankings
Lower fee for using 'best value' physicians
By Jeffrey Krasner, Boston Globe
January 27, 2006

The agency that oversees health insurance for 144,000 state workers wants to launch a program to control runaway healthcare expenses: a ranking of doctors' quality and efficiency that would be tied to lower copayments for patients who seek care from higher-rated doctors.

The Group Insurance Commission this morning will examine proposals it requested from Harvard Pilgrim Healthcare, Tufts Health Plan, Health New England, Fallon Community Health Plan, and other insurance companies. A key feature of each proposal is variable copayments. For example, under the Harvard Pilgrim and Tufts scenarios patients would pay $15 to visit a doctor who is rated highly and $25 to see one with a lower rating.

... ''We don't want people making decisions on their healthcare based on inaccurate or misleading information," said Dr. Alan M. Harvey, a anesthesiologist and president of the Massachusetts Medical Society, a doctors' group. ''If the GIC decides to go ahead without accurate information, that's not fair for patients or physicians."

The move to provide information on individual physicians is another in a series of pioneering steps by the Group Insurance Commission. Two years ago, it required that health companies bidding for its business rank hospitals. The result was Navigator, a Tufts insurance plan that offered varying copayments based on quality rankings. Navigator became so popular that Tufts offered it to other businesses, and the approach has now become widespread. That could also happen with plans that rank individual doctors.

See whole article at URL.

What are the odds that "inaccurate or misleading information", derived as only non-clinicians with financial conflicts of interest or other axes to grind can do from even the finest EMR, will be used in this program?

I believe such odds are high, and the horrid performance of an information system designed to prevent child abuse, above, not just measure clinical "quality", certainly doesn't contradict my opinion.

I should add that my having to see these stories about health-related IT debacles is a form of adult abuse. It is simply incredible.

-- SS

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